Language Disorder DSM-5 315.39 (F80.9)

DSM-5 Category: Neurodevelopmental Disorders

Communication Disorders

A language disorder is an impairment in the processing of linguistic information that affects an individual’s ability to receive and/or express language. According to DSM-V, the disorder involves persistent difficulties in the comprehension or production of spoken, written, sign language, or other forms of language. The individual may not demonstrate age-appropriate language disabilities. A language disorder is different from a speech disorder, which involves problems with the articulation and fluency of speech sounds. Difficulties may arise in language form, content or function.

Language disorders are one of the four disorders classified under communication disorders by DSM-V. The other three are speech disorders, central auditory processing disorders and hearing disorders. Communication disorders, which may have a severity range from mild to profound, interfere with an individual’s ability to function in daily life (American Speech-Language Association, 1993). At any age, stroke, brain injuries, disease or seizures may lead to communication disorders.

Types of Language Disorders

Expressive language disorders involve deficits in verbal and written expression. Deficits may involve articulation, vocabulary, sentence formation and memory. A child’s language ability will lag that of his/her peers in areas such as word choice and usage, sentence formation and grammar. Receptive language disorders involve deficits in comprehension. In children, signs may include not listening to or following instructions and repeating words or phrases heard, a symptom called echolalia. Mixed Receptive-Expressive Language Disorder involves problems with both expressive and receptive communication. Many individuals experience deficits in both areas. An individual may also show signs of dyscalculia (problems with arithmetic) or spatial concepts.

Forms of Language – involve phonology (speech sounds and patterns), morphology (how words are formed) and syntax (the formation of phrases and clauses).

Content of Language – involves semantics or the meanings of words.

Function of Language – involves pragmatics or how language is used by individuals in different contexts.

Impact of Language Disorders on Daily Life

An individual with a language disorder may appear detached from others in a family, school or play environment. He may also lack confidence and assertiveness as a result of difficulties comprehending and expressing information. Language disorders are typically identified in early childhood when a child fails to display age-appropriate language abilities. The child may fail to follow instructions, ask or answer questions, show appropriate emotions (e.g., respond to humor), or interact normally with peers. The most effective therapies for language disorders are those that are conducted in these natural environments. The individual not only learns faster in a natural environment but also more easily maintains the new behavior and skills in these familiar settings.

Language Disorder Therapies

Speech-language therapy is the most common form of treatment for language disorders. The speech-language pathologist works with a multidisciplinary team of audiologists, Behavioral therapists and special education professionals, as well as doctors to identify (or rule out) physical causes behind language impairments. In addition to addressing language disorder deficits in phonology, morphology, syntax and semantics, the therapist also focuses on cognition, speech and voice.

Language therapy is a key component of Behavioral therapies, the most popular treatment for communication disorders. Recognizing that natural environments provide the best learning experience, increasingly, family members and caretakers are training in Behavioral therapy methods such as Applied Behavior Analysis (ABA). Special education teachers are also trained in ABA methods, allowing for reinforcement across environments.

ABA uses a three contingency approach of antecedents-behavior-consequences to respond to behavior in a natural environment, reward or punish unwanted behavior and reinforce positive and learned behavior. For example, a child who asks for a cookie by name “cookie” will be given a cookie as a reward. If the child pulls mom’s arm or grunts for the cookie, the snack will be withheld. The behavior is repeated each day to teach and reinforce the language skill.

A powerful communication tool being used with ABA and other therapies is touch mobile technologies, such as the iPad, iPhone and other tablet devices, to improve communication and social skills. Argumentative and alternative communication apps are popular due to their ease of use and cost, and importantly, social acceptability (Bradshaw, 2013). Overdependence on mobile apps, however, by education and communication professionals may affect the effectiveness of an intervention. Communication and educational professionals must foremost focus on the communication needs of the individual, and ensure the app addresses those needs (Light & McNaughton, 2013).

Play programs are also being used in conjunction with ABA and other therapies, as well as alone. Self-directed pretend play has shown to improve social and language skills (Stagnitti, O'Connor, & Sheppard, 2012). More structured therapy/play programs have also produced long-term Improvements in both expressive and communication skills (Reynolds, Stagnitti, & Kidd, 2011). Children participating in these programs have shown improved self-confidence as their communication and social skills improved (Wettig, Coleman, & Geider, 2011).

Music therapy has proven to be efficacious in treating speech and language deficits. For example, singing lessons provide a good opportunity to practice both language and voice skills. Ongoing research in brain plasticity is providing a better understanding of how music and other forms of therapy affect language processing, allowing for more targeted treatments. Specific forms of therapy include melodic intonation, rhythmic rehabilitation, entrainment and a combination of music/play therapy.

Early identification of language disorders is key to early intervention, which studies have shown produces better long-term treatment results.

References

American Speech-Language Association. (1993). Definitions of communication disorders and variations. Retrieved from http://www.asha.org/policy/RP1993-00208/

Bradshaw, J. (2013). The use of augmentative and alternative communication apps for the iPad, iPod and iPhone: an overview of recent developments. Tizard Learning Disability Review, 18(1), 31-37.

Reynolds, E., Stagnitti, K., & Kidd, E. (2011). Play, language and social skills of children attending a play-based curriculum school and a traditionally structured classroom curriculum school in low socioeconomic areas. Australasian journal of early childhood, 36(4), 120-130.

Stagnitti, K., O'Connor, C., & Sheppard, L. (2012). Impact of the Learn to Play program on play, social competence and language for children aged 5–8 years who attend a specialist school. Australian occupational therapy journal, 59(4), 302-311.

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